Research Article

iMedPub Journals 2017

http://www.imedpub.com Integrative Journal of Global Health Vol. 1 No. 2:11

Assessment of Knowledge, Attitude and Yayehyirad Yemaneh and

Bamlaku Birie
Utilization of Long Acting Family Planning
Method among Women of Reproductive Department of Midwifery, College of Health
Sciences, Mizan-Tepi University, Ethiopia
Age Groupe in Mizan-Aman Twon, Bench-
Majizone, South West Ethiopia, 2016
Corresponding author:
Yayehyirad Yemaneh

Abstract  buchiatuog@gmail.com
Background: Family planning is having the number of child you want to have and
when you want them. Knowledge and utilization on long acting and reversible family Department of Midwifery, College of Health
planning plays a major role in reducing maternal and child morbidity and mortality Sciences, Mizan-Tepi University, Ethiopia.
rate. In addition, family planning encourages women to have better health and it
increases female’s exposure to work place productive activity. Currently, the world Tel: 251932520242
population growth is increasing through time to time in fastest manner. Such kinds
of problems are much significant in developing countries like that of Ethiopia. This
is true because currently Ethiopia is one of the most populated countries in Africa.
Citation: Yemaneh Y, Birie B. Assessment
Objective: To assess the knowledge, attitude and utilization of long acting family of Knowledge, Attitude and Utilization of
planning method among women of reproductive age group in Mizan-Aman town, Long Acting Family Planning Method among
in selected Keble’s.
Women of Reproductive Age Groupe in
Methodology: A community based Descriptive cross-sectional study was Mizan-Aman Twon, Bench-Majizone, South
conducted from April 08 to April 30, 2016 G C among reproductive aged women. West Ethiopia, 2016. Integr J Glob Health.
The Study was conducted in selected Keble’s in Mizan teferi, Ethiopia. Multi 2017, 1:2.
stage sampling technique was used to select 731 study participants. A pre-test
and structured questionnaire was used to collect the data and all the returned
questioners were cleaned and coded manually and transferred to spss version 20
for further analysis, descriptive statistics was used and tables and graphs were
used.
Result: A total of 731 reproductive age women were included in the analysis. The
proportions of respondents who had low, moderate, and high knowledge was
6.06%, 52.02%, and 42% respectively and 65.02% of women had positive attitudes.
Only 18.2% of the respondent's utilized LAFPMs which is still dominated by short
acting methods that was injectable.
Recommendation: For Mizan-Aman health bureau and other stakeholder work on
family planning: strengthen continuous education on LAFPMs by model LAFPMs
users and advocate for method uptake during clinic visit. Health extension workers
should enhance discussion between couples.
Keywords: Long acting; Family planning
Abbreviations: CSA: Central Statistics Authority; EC: Ethiopian Calendar; EDHS:
Ethiopian Demographic Health Survey; FP: Family Planning; GC: Gregorian
Calendar; IUCD: Intra Uterine Contraceptive Service; KAP: Knowledge, Attitude and
Practice; LAFPMs: Long Acting Family Planning Methods; PI: Principal Investigator;
TFR: Total Fertility Rate; UNESAPD: United Nations Economics and Social Affairs
Division; USAID: United Nation Aid for International Developments; WCA: Women
of Child Bearing Age; WHO: World Health Organization.

Received: June 28, 2017; Accepted: July 17, 2017; Published: July 28, 2017

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Integrative Journal of Global Health
Introduction
Family planning is defined having the number of children you want
when you want them. It is achieved through use of contraceptive
methods [1].
Family planning is voluntary use of natural or modern
contraceptive by individual or couples. This approach helps the
users to have the number of children they want to have and to
assure the wellbeing of children as well as parents. The goal of
FP is to decrease the rapid growth of population so that if will be
compatible with living standard of the people. It also contributes
for the effort to create sustained and efficient use of countries
resources [2].
There are traditional methods of family planning, which is
divided in to withdrawal and rhythm, and there are modern
family planning methods, which is divided in to three: long
acting reversible contraceptive methods (IUCD and Implants);
permanent contraceptive methods (Tubal ligation for females
and vasectomy for male) and short-term contraceptive methods
(oral pills, injectable, male and female condoms, foam tablet and
cervical cup [3].
Intra uterine contraceptive devices [IUCD] and implants are
long acting reversible contraceptive methods (LARCM); when
removed, return to fertility is prompt [4].
Modern family planning methods account for the majority of
current global contraceptive practices; almost nine out of every
ten contraceptive users rely on a modern method. Female
sterilization, intra uterine device and oral pills account for more
than two-third of all contraceptive practice worldwide [5].
Globally, female sterilization is the single most used method and
alone accounts for one-third of all contraceptive use worldwide.
The IUCD is used by (22%) of all contraceptive users and the oral
pill by (14%). The use of modern contraceptive methods differs
significantly between the developing and developed areas. In the
developing areas modern methods account for much larger share
of total contraceptive use (90%) than in the developed areas
(70%) [5].
In Ethiopia, the progress of contraceptive prevalence rate (CPR)
is increased to 42 percent and total fertility rate of four [6].
Understanding the magnitude of need for modern family planning
services, the Federal Ministry of health (FMOH) has considered
the important role of long acting contraceptive methods and aim
to provide all family planning clients with the long acting and
permanent methods [7].
Currently, family planning becomes an important issue throughout
the whole world. This is because of the unexpected and rapid
population growth, as a result exposes to high maternal mortality
and even the level of economic development and health care
demands that uncontrolled fertility rate negatively effects on the
family and the society as a whole [8].
Starting from the 1960, family planning service has become the
major worldwide activity to influence fertility in the year 1965
family planning was accepted as an issue by only 21 countries, but
in less than two decades, to mean that in 1983, access to family
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planning method in its modern way was limited in only seven
countries useable, it is less than 1% of the world’s population [9].
Ethiopia’s population policy has been promoting the family
planning method since 1989. Family planning contribute in
the reduction of maternal and child mortality and morbidity,
unwanted pregnancy and its consequence. In addition to this
family planning encourages women to actively participate in
production? In some regions community based on FP service
have shown a significant progress in political, economic and social
aspects. Therefore, in order to enhance the access of FP for house
hold at community level Family planning extension package was
designed [10]. This package is also important strategic tool to
decrease maternal death by spacing or preventing pregnancies
that occur too early or too close. This could avoid about 20%
of maternal death or over 2500 maternal death and pregnancy
related death over year in Ethiopia [11].
Long acting and permanent methods are by far the most effective
type of modern contraception (with success rate of 99% or
higher) and they are very safe, convenient and cost effective in
the long run. This includes IUCD, Implants. They are all clinical
methods and must be provided in health facilities by trained
health professionals.
The world population in the year 1987 GC was 5 billion and it
became 6 billion in year 2000 GC. Thus, it is increasing by 1.4% per
year approximately. Therefore, if this rate of growth continues in
such manner, the population will be 10 billion in 2035 [1]. If this
rate of population growth continues in such manner, it will result
economically, socially and health crisis throughout the world.
Unable to use modern contraceptives leads to unwanted
pregnancy which intern results economic and social problem in
the family. If the mother is giving birth frequently without enough
gaps in between, she is stayed at home rearing her children. This
problem prevents her from being active participant in the country
and she will draw from social activity, it causes famine and
makes the ecosystem unfavorable [12]. In terms of Health crisis
unplanned pregnancy is known to represent a serious problem in
Ethiopia today although only limited empirical data are correctly
available. But the 2005 district hospital finding show more than
20-40% death of mothers is due to the complication of unsafe
abortion. Most victim of unplanned pregnancy was adolescent.
Giving birth at extreme age i.e., at early adult hood age and near
to Menopause periods has health burden for both the mother
and the neonate [13].
Currently, the world population growth is increasing through
time to time in fastest manner. Such kinds of problems are much
significant in developing countries like that of Ethiopia. This is
true because currently Ethiopia is one of the most populated
countries in Africa [14-20].
According to the 2014 GC Ethiopian mini demographic health
survey (EMDHS) the total fertility rate in the mentioned year was
4.1 children per woman. The data show that the TFR decreased
only slightly from 5.5 children in 2000 to 5.4 children in 2005, with
a more pronounced decline to 4.8 children in 2011. This trend
continues between 2011 and 2014 with fertility declining by 0.7
children per women. There are variations in TFR among regions of
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developing and developed once. That is ranging from 1.7 children
per woman in Addis Ababa (below the replacement level of
fertility) to 6.4 children per woman in Somali. Fertility levels are
higher than the national average in Somali, Benishangul-Gumuz,
Afar, Tigray, Oromiya and SNNP. The level of fertility is inversely
related to women’s educational attainment, decreasing from 5.0
children among women with no education to about 2 children
each among women who have secondary or higher education
[14,15].
Therefore, creating awareness about family planning, increasing
family planning service provision & again reducing the cost of
family planning service are the basic element to minimize the
fast growing of population in Ethiopia. However, despite many
advantages long acting family planning service utilization remains
relatively small and sometimes missing components of many
national reproductive health and family planning method. Such
studies will assess the knowledge, attitude and utilization of
LAFPMs among reproductive age of women in Mizan Aman town.
Methodology
Study design
¾¾ A community based descriptive cross- sectional study was
conducted.
Study area and period
This study was conducted from April 08 to April 30, 2016 EC
Study population
¾¾ Systematically Randomly Selected women of child bearing
age living in Mizan-Aman town, in selected kebeles
Study unit
¾¾ Individual.
Inclusion criteria
All women of child bearing age living in Mizan-Aman town,
Kommeta and Adis ketema Kebele.
Exclusion criteria
¾¾ Woman who stays in the study area for less than 6 months.
¾¾ Women who are unable to communicate.
¾¾ Women who are living outside the specified Keble.
Sample size, sampling technique and sampling
procedure
Sample size: The sample size for this particular study was
determined by using single population proportion formula using a
basic assumption of 95% confidence level, 5% margin of error and
Proportion (P): proportion of long acting reversible contraceptive
Method (LARCM) use was 34.8% among family planning users in
Addis Ababa and using the formula,
Z 2 P (1 − P ) , (1.96 ) 0.348 (1 − 0.348) 348
2

in Bench-Maji Zone Mizan-Aman town. The zone has total = ni = 2 ni =

population of 760,314; of which 381, 449 are males and 378,865 d ( 0.05)
2

are Females. MizanTeferi with the neighbouring town of Aman Since it is multi stage sampling technique so by using design
forms a separate woreda called Mizan-Aman surrounded by effect and multiplying by 2 becomes 696 and Contingency (for
south Bench Woreda. Mizan-Aman town is the largest town non-response=5%) =34.8=35 so the final sample size is nf=731.
and administrative center for Bench -Magi Zone. This town has
latitude and longitude of 7°0ˈN 35°35ˈE/7.000°N 35.583°E and Assumptions
an elevation of 1451 m above sea level. The zone has 33 health ni=initial sample size; 348; nf=Final sample size=731; Z=confidence
centers, one General Hospital, and also the location of two level which were 95%; P=proportion=34.8%; d=the margin of
institutions of Higher education, namely Aman Health Science error was taken as 5%.
College and Mizan-Tepi University. The General Hospital is located
in Aman town and established in 1986. According to the South Sampling technique: Multi-stage sampling Technique was used
Nations Nationalities and Peoples Region Bureau of finance and to select the study subjects.
economic Development, as of 2003 MizanTefere’s amenities also Sampling procedure: The study was conducted in two Keble’s
include digital telephone access, postal service, and a bank and a of Mizan-Aman town. From five Keble’s found in Mizan-Aman
hospital. Near the town is the Bebeka coffee plantation. Based on town, two Keble’s were selected using simple random sampling
the 2008 census conducted by central statistics Agency, Mizan- method (lottery method). The sample size was allocated to
Aman woreda has a total population of 48,934 of whom 23,978 each Keble’s by proportional to size of house hold from selected
are men and 24,959 are women. The majority of the inhabitants Keble’s by considering that there is at least one reproductive age
practiced Ethiopian Orthodox Christianity, with 45.97% of the women per house hold. The study participants were selected by
population reporting that belief, 33.8% were Protestants, 17.71% systematic sampling method from those selected Keble’s. The
were Muslim, and 1.05% practiced traditional beliefs. first house was selected by lottery method to avoid bias and was
Target population continued every Kth interval (5th interval). The sampling interval of
households in each Keble was determined by dividing the total
¾¾ All women of child bearing age living in Mizan-Aman town. number of house hold to final sample size. when two or more
children bearing age women were present in one household,
Source population only one women was considered in the study on random to avoid
¾¾ All women of child bearing age living in Mizan-Aman town, intra-class correlation.
in selected kebeles. N
K=
nf

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Integrative Journal of Global Health
4, 012
K
= = 5.41
= 5
731
where, N=total Number of House Hold; nf=final sample size;
K=Sampling interval.
Data collection tool and procedure
The data was collected by carefully designed and standardized
questionnaires which were developed from deferent literatures.
The questionnaire was developed in English language originally
and translated to Amharic. The study instrument was taken from
studies done in Addis Ababa town. The survey questionnaire was
pre -tested and the necessary modifications and correction took
place to ensure its validity.
The data was collected by six 4th year midwifery studentsin April
08 to 30 2008 EC from selected Keble’s. To maintain the quality
and uniformity of the data we discussed on how to approach and
collect the data. Then, we were taken an ethical clearance from
department of midwifery, college of health science, Mizan-Tepi
University, and woreda health office. During data collection, we
were told the significance of the research to the respondents then
take consent of the respondents. After that collect, the data using
manual structure and well organized questionnaire prepared for
face to face interview by translating it to Amharic language then
go back to English. After collecting the data, we were checked the
completeness of each question.
Data quality control
To keep the consistency of the questionnaire, it was first prepared
in English and then translate into Amharic and back to English in
order to keep its consistency. A pre-test was done on 10% (73)
of the study unit 1 week prior to data collection outside selected
Keble’s in Mizan-Aman town and modification was done according
to the pre-test. The data collectors were check the completeness
of the questioner before the leave each questioner. Supervision
was done by principal investigators together for data quality and
completeness. Each questionnaire was given a unique code by
the Principal Investigator. The principal investigator prepared
the template and entered data using SPSS version 20 then, the
entered data were cleaned for anomalies prior to data analysis.
Frequency distributions were used to check for missed values and
outliers during analysis. Any errors were corrected after revision
of the original data using the code numbers of the questionnaires.
Data were cleaned for inconsistencies and missing values and
analyzed using SPSS version 20 statistical software.
Data analysis and processing
The data was analyzed using Statistical Package for social science
(SPSS) version 20. Women’s knowledge was measured by the
total number of correct answers to six items of knowledge with a
minimum score of zero and maximum six. Measure of knowledge
was categorized based on the percent of knowledge of the distinct
characteristics of LAFPMs as high those who knew 75% and above,
moderate those who knew 50-74% and low those who knew less
50%. The study participant’s attitude was measured as positive
and negative attitude. Three-point attitude likert scales were
used with six attitude questions considered, and those that have
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ARCHIVOS DE MEDICINA 2017
ISSN 1698-9465 Vol. 1 No. 2: 11
scored above mean was grouped as positive attitude and mean
or below mean were grouped as negative attitude. Frequencies
and Proportions were computed for a description of the study
population in relation to socio-demographic and other relevant
variables (age, marital status, no children). Descriptive statistics
like frequency distribution mean and standard deviation was
used. The results were presented in the form of tables, figures
and summary statistics (Figure 1; Tables 1-9).
Ethical consideration
Official letter was written from Mizan-Tepi university college
of Health Sciences department of Midwifery to Mizan-Aman
Town health administration office and in turn Mizan-Aman Town
health administration office was written letter to Kometa and
Adisketema Keble administration office in order to get permission
and cooperation. The oral consent from the respondent was
obtained and assured the confidentiality of the respondents.
Then the purpose of the study explained for the participants.
Individuals had full right to be involved in the study or not.
Dissemination of plan
The finding of this study will be presented and submitted to Mizan-
Tepi University college of health science Department of Midwifery
The final findings of this study will be disseminated to Bench Maji
zone health bureau, North Bench health office. Effort will be made
to publish on peer review journal to make accessible for peoples.
Results
Socio demographic characteristics
A total of 731 child bearing age women were included in the
interview making a response rate of 100%. Among those study
participant’s, 332(45.5%) were at the age of 25-34 years, 260
(38.4%) were at the age of15-24and,119(16.2%) were in the
range of 35-44 years old. The mean age of participants was
26.6 ± 6.05. Out of 731 study participants’ 126(18.2%) were
LARCM users, and majority of them 57(45.2%) were in the age
range of 25-34 years. With regard to Marital status of study 731
participants Majority 516(70.1%) were Married while 20(2.7%)
were cohabiting. LARCM users (n=133), 80(60.3%) were married.
out of 731 Study participants 298(40.8%) were orthodox Christian
followers 235(32.1%) were Protestants. Majority 204(27.9%)
of women from study participants were Amhara by ethnicity.
Concerning their educational status of study participants
350(47.9%) had secondary education while 16(2.2%) graduated
from higher education (BSC and above). LARCM users (n=133),
42(31.6%) had primary education and 4(2.6%) were Women with
no formal education. Regarding occupational status of 731study
participants, majority of the respondents 358(48.97%) were house
wives and the least 26(3.55%) were self-employed (Table 1).
Reproductive history of study participants
From a total of 731 study participants, 586 (80.3) had given
birth Previously of these 370 (63.1%) had 1-2 children while 88
(15.01%) had 3-4 children, 472 (80.5%) gave birth at the age of
less than 20 years and one hundred twenty-two (16.7%) had
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Table 1 Showing the Socio-Demographic characteristics. Table 2 showing the reproductive Characteristics.
S.No Socio demographic Number (731) Percent Number of alive children
Frequency Percentage%
1 Marital status (586)
Single 105 14.2 1-2 366 62.45
Divorced 30 4.1 3-4 154 26.27
Separated 30 4.1 >4 66 11.26
Widowed 30 4.1 (17.91%) did not know that IUCD can prevent pregnancy for 12
2 Religion
years, 433 (59.25%) did know that IUCD do not interferes with
Muslim 192 26.3
sexual intercourse, five hundred and forty-seven (74.85%) of the
Others 6 0.8
study participants had knowledge about the notion that Implant
3 Ethnicity
prevents pregnancy for 3-5 years. Among the study participants,
Oromo 176 24.1
502 (68.78%) had knowledge that after immediate removal of
Kaffa 66 9
Tigrie 96 13.2 Implant, women become pregnant. From women of reproductive
Bench 65 8.8 age group study participants (n=731), 381 (52.02%) had moderate
Others 124 17 knowledge and the least 44 (6.06%) had low knowledge and from
4 Educational status LAFPMS users (n=133), 100 (75.5%) had high knowledge and the
No educational 61 8.2 least 11 (7.93%) had low knowledge (Table 3).
Elementary 120 16.4
Attitude of study participants towards long acting
Secondary 350 47.9
Diploma 184 25.2
family planning methods
Higher education 16 2.2 Among 731 women’s of reproductive age groups in this study
5 Occupational Status area, 266 (36.41%) thought that Implant does not causes irregular
Government employee 70 9.6 vaginal bleeding and 129 (17.63%) reported that insertion and
Self-employee 26 3.6 removal of Implant was not highly painful. One hundred and
Merchant 166 22.7 fourteen (15.54%) agreed that insertion of IUCD does not lead
Hand craft makers 10 1.4 to lose privacy and 108 (14.74%) said that IUCD do not restrict
House wife 358 49
from performing daily activities. From 731 study participants 476
Daily labourer 60 8.2
(65.02%) had positive attitude and out of (133%) LAFP users 70
Student 41 5.5
(52.3%) had supportive attitude (Tables 4 and 5).
History of abortion, the mean age of first marriage and first birth Utilization long acting family planning methods
were 16.68 ± 2.13, and 18.63 ± 2.18 years, respectively. Out of
731study participants 516(70.5%) were married, out of this
among women’s heard of long acting family
majority 408(78.9%) got married at the age of less than 18 years planning methods
and Out of 133 (18.2%) LARCM users, 101(80%) were married at From 731 reproductive age women’s, most of the participants,
the age of 18 and above and 111(87.5%) had given birth at the 562 (76.87%) were utilized modern family planning methods of
ageof20 and above. From 133 LARCM users, 70(52.5%) had 3-4 these Majority 370 (50.52%) used injectables,133 (18.2%) utilized
children and twenty-one (17.9%) had history of abortion (Table 2). long acting family planning methods and least 12 (1.7%) used
IUCD (Table 6).
Source of information on modern and LAFPMs
In this study, 692 (94.6%) were used modern family planning
among study participants method on the previous service and the most preferred method
Out of 731 participants, majority of them 707 (96.7%), heard/aware that 412 (59.53%)study participants ever used were inject able
about modern family planning of these respondents who have had and least 10 (1.44%) used was IUCD. From 731 women’s of
information about modern family planning methods, 692 (98.15%) of reproductive age groups, 447 (61.1%) women were shifted/switch
them had information/awareness about Long acting family planning from one contraceptive method to other contraceptive method.
methods and 470 (68.1%) were heard message through mass media Among those women’s, majority 208 (46.5%) were shifted/
within 12 months on LARCMs. From 707 (96.7%) study participants switched from short to long acting contraceptive method. Out of
who have had information about modern family planning methods, 133(%) the LAFPMs users, 113 (84.6%) were shifted from short
312 (44.1%) heard from health professional followed by 192 (27.1%) to long acting contraceptive methods, main reason to shift from
were from mass media, 121 (17%) were from Relatives and 82 one contraceptive method to another contraceptive method,
(11.6%) were from their Husbands. 181(40.42) were need for long acting followed by 138 (30.96%)
were provider advise (Table 7).
Knowledge of women about long acting family From the current modern family planning users who are not using
planning methods LARCM (n=428), their main Reason 187 (43.5%) were need for
In this study, a total of 731 reproductive age women’s who short acting and least 4(0.9%) were due to medical causes. Main
have information on LAFPMs were interviewed. Of these 130 reason for not utilizing long acting (n=428).

© Under License of Creative Commons Attribution 3.0 License 5

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Mizan-Aman Town

Hibret Keble Addis ketema Keble Ediget Keble Kometa Keble Shesheka Keble

Simple random sampling

Addis ketema Keble Kometa Keble

Total Household Total House Hold

2416 1596

Systematic Sampling Method

Sample Household Sample House Hold

438 293

731 Household

Figure 1 Schematic presentation of sampling Procedure.

Table 3 Showing Knowledge of Study Participants.

Knowledge statements of women reproductive age on LAFPMs(731) True False
No % No %
IUCD can prevent pregnancies for 12years 601 82.08 130 17.91
IUCD can prevent Sexually transmitted Infections(STIs) 212 28.9 519 71.1
IUCD interfere with sexual intercourse or desire 298 40.75 433 59.25
Implant can prevent pregnancies for 3-5 years 547 74.85 134 25.15
Implant caninterfere with sexual intercourse or desire 203 27.74 528 72.26
Implants reverse pregnancy quickly when removed if the women need to be pregnant 502 68.78 229 31.22
Knowledge score of respondents(731)
Level of knowledge Number Percent
High 306 41.9
Moderate 381 52.02
Low 44 6.06

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Table 4 Showing Attitude of Study Participants Towards Long Acting Family Planning Methods.
Attitude on long acting family Agree Not Sure Disagree
planning methods (n=731) No % No % No %
Using implant does not cause irregular
266 36.41 250 34.10 215 29.47
bleeding
Insertion of intrauterine Contraceptive
114 15.54 390 54.04 227 31.05
devices does not lead to lose privacy
IUCD doesn’t move through the body
127 17.34 322 43.64 285 39.01
after insertion.
Using intrauterine contraceptive
devices do not restrict normal 108 14.74 285 39.01 338 46.24
activities.
Insertion and removal of implant is
129 17.63 203 27.74 399 54.62
not highly painful.
Implant doesn’t move through the
123 16.76 160 21.96 448 61.27
body after insertion.
Attitude score towards LARCM
Number (731) Percent
Positive attitude 476 65.02
Negative attitude 255 34.98

Table 5 Showing utilization of long acting family planning method.

Variable No %
Pills 48 6.64
Injectable 370 50.52
Implant 122 16.47
IUCD 12 1.7
Other 10 1.4

Table 6 Showing utilization of modern and LARCMs of study participant.

S.No Variables Frequency Percent
1 Which type of modern contraceptive? Method has you ever used
Pills 110 15.89
Injectable 412 59.53
Implant 84 12.2
Others 76 10.9
2 From which contraceptive method to which Contraceptive method (recent one)? (n=447)
Long to long 21 4.7
Long to short 119 26.5
Short to long 208 46.5
Short to short 99 22.2
3 Why did you shift/switch from one method to another? (n=447)
For inconveniency of previous method 17 3.78
For convenience of new method 53 11.82
Due to lack of access to the previous method 12 2.6
Due to side effect 46 10.4

Table 7 Showing reasons for not using long acting family planning
Discussion method.
The results of the study revealed that the proportion of women Variable Frequency Percent
who had ever heard about LAFPMs was 692 (94.7%) and the Misconception 139 32.5
proportions of respondents who had low, moderate, and high
Fear of Side effect 78 18.2
knowledge was 6.06%, 52.02%, and 42% respectively. This
is higher than study done in Addis Ababa, Ambo and Mizan Fear of infertility 20 4.67

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Integrative Journal of Global Health
Aman town 21.3%, 36.4% and 33% of respondents had high
knowledge, this indicates as there is an improvement in the
level of awareness which may be explained by advancement of
information, education and communication to the community by
media and health extension workers. But it is lower than study
done in Debremarkos town which was 81.5% and in Ethiopian
demographic and health survey of 2014 the level of awareness
for IUCD and implant was 38.9% and 73.5% respectively, this
may be due to different socio demographic characteristics, study
design and sample size. In this study, participants awareness
of effective duration of effectiveness of IUCD and implant was
(82%) and (74.85%) respectively, it was higher than study done in
Uganda which was IUCD (68.5%) and implant (69.9%) and Addis
Ababa IUCD (40.6%) and implant (64.3%) [22-35], this may be
due to that the government has given due attention and change
of communities' awareness and perception through mass media
advertisement. This may be also the contribution of HEW. And
it was in line with study done in Ambo IUCD (79%) and implant
(84.4%) [36].
Regarding to the attitude this study revealed that 65.02% and
34.9% of women had positive and negative attitudes respectively.
This shows more than half of study participants had positive
attitude as compared to study done in Mekele (53.6%) of study
participants had negative attitude [32], this discrepancy may
be due to socio economic variations and different awareness
creating techniques between communities and health extension
workers among different towns. And it was in line with study
done in Ambo (51.7%) had positive attitude [36].
This study also shows 29.47%, of women perceived that implant
causes irregular bleeding, this is higher than study done in Ambo
(15.5%), and lower than study done in Mekele (50.5%). 54.6%
and 31.05 of women perceived that implant causes severe pain
during insertion and removal, this is also higher than study done
in Ambo (26.6%). Acceptance in the current study might be due
to its convenience and there are no cultural influences related
to the procedure of implant that leads to have a positive effect
on the acceptance of LAFPM. And in line with study done in
Mekele (46.6%) [32-36]. In this study 31.5% ofwomen perceived
that IUCD causes shame while it is inserted to cervix by health
professional. This is similar with study done in Ambo (29.7%)and
Mekele (29.7%) [32-36].
The results of the study also revealed that the proportion of
women currently using LAFPMs was 18.2 % in the Town/District.
This result ishigher than Arba Minch whichwas 13.1% [37], this
might be due to; having positive attitude was prerequisite for
using contraceptive method. And lower than study conducted in
Ambo town, Addis Ababa and Uganda which was 31.8%, 34.8%
and 31.7% respectively (36-35-22). The possible explanation
for the difference is that as socio demographic, cultural values,
sample size and study design may have contribution.
Current use of IUCDin this study area was 1.7%, which was higher
than EMDHS 2014 which was 1% [15], and similar with study
done in Denbrebrehan (2.8%) [34]. However, it is lower than
study done in Kenya (14.4%), Ambo (6%) and Addis Ababa (6%)
[24,35,36] this low result also might be due to women aged 15-24
were at the beginning of childbearing age hence they had limited
8 This article is available in: http://www.imedpub.com/integrative-journal-of-global-health/
ARCHIVOS DE MEDICINA 2017
ISSN 1698-9465 Vol. 1 No. 2: 11
utilization of IUCD due to need of short acting methods for more
birth.
The current use of implant was 16.5% which was greater than in
Adigrt town in Tigre region (10.2%)and EMDHS 2014 which was
4.9% [15,35], and it was in line with Debrebrehan town (16.4%)
and Ambo (17.7%) [34-37]. But it was lower than study done in
Addis Ababa (22.4%) [38,39].
Strengths and Limitations of the study
Strengths
¾¾ Inclusion of study participants from rural and urban part of
the District.
Limitations
¾¾ Perceived social-desirability of responses rather than actual
knowledge or practices could be response biases.
¾¾ The study used to assess based on only client perspective
but other perspectives such as Professional counselling,
availability of adequate supply, trained professional and
others might have significance.
Conclusion and Recommendation
Conclusion
In this study, approximately 42% of study participants among
reproductive age groups had high knowledge; only 6% of women
have had low knowledge. And 65% of study participants had
positive attitude towards long acting family planning methods,
but the utilization remains low (18.2%) which is still dominated by
short acting method that were Injectable followed by implants.
Recommendation
Based on the findings of the study the following recommendation
will be forwarded for:
¾¾ Federal Ministry of Health,
¾¾ South Nations, Nationalities and Peoples Regional health
bureau,
¾¾ MizanAman health bureau,
¾¾ Mizan-Aman Teaching Hospital,
¾¾ Mizan Health center,
¾¾ For Service providers,
¾¾ For researchers
Aknowledgement
We would like to thank our data collectors for their unreserved
time and cooperation and also our thanks will goes to Mizan-Tepi
university for the full coverage of the budget allocated last but
not least we thanks all who were with us and who shared their
ideas when needed.
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